Improving the oral health of the public and the professional development of ASDA members

Dental spending increased by $4B in 2023

A new study released by the American Dental Association’s Health Policy Institute shows dental spending in the U.S. increased by 2.5% between 2022 and 2023. The near-entirety of the year’s $4 billion growth is attributed to $3 billion in increased Medicare spending by seniors enrolled in Medicare Advantage plans and $1 billion in increased Medicaid spending.

While government spending on dentistry has increased substantially, private insurance and out-of-pocket spending has dipped slightly by 0.4% and 0.7%, respectively.

For more information and data, click here.

Open Letter to Legislators Re: Medicaid

The dentists of Arkansas and the Arkansas State Dental Association (ASDA) proudly support the Arkansas Medicaid dental program.  With one of the highest participation rates in the nation, more than 700 Medicaid-enrolled dentists currently treat those patients most in need of dental care across our state.  However, the decision to enroll and re-enroll as Medicaid providers grows increasingly difficult for Arkansas dentists.  The rising costs of materials, lab fees, and staff time associated with dental Medicaid coverage are but a few of the issues our dentists face.  Moreover, the reimbursement rate for Medicaid-covered services last set back in 2007 inadequately addresses these expenses.

As you may know, the Arkansas Department of Human Services (DHS) recently opted not to continue with the dental managed care organization (MCO) system which facilitated the dental Medicaid system for the last several years.  Instead, DHS decided to transition Arkansas dental Medicaid back to a fee for service (FFS) system.  This means that Medicaid-enrolled dental practices will now be directly responsible for keeping track of and filing claims for Medicaid-covered services and seek to be reimbursed directly for those services.  While cutting out the middleman serves to cut costs for DHS, this change incurs additional staff time and costs on enrolled dental practices.  As a result, many dentists face the difficult choice of whether to continue as a Medicaid provider. 

A 2022 survey of Arkansas dentists (n=212) currently providing services to Arkansas Medicaid beneficiaries indicated some serious concerns:

  • 90.4% of responding dentists indicated that Arkansas Medicaid does not adequately reimburse them for services provided.
  • 73.6% indicated that if Medicaid rates remain at the current level they may have to stop treating Medicaid beneficiaries in the future.
  • Only 7.6% of dentists indicated that they will still be Medicaid providers within 3 years of 2022 if rates do not increase.       

The Medicaid dental providers of Arkansas raised these concerns over two years ago, and they only grow larger and more dire today.  As 2025 fast approaches, so too approaches an access-to-care crisis for one of Arkansas’ most vulnerable patient demographics.  Nothing short of prompt and decisive support by DHS will avert this looming cessation in dental Medicaid coverage.     

RATIONALE and REQUEST:

On behalf of all current Medicaid-enrolled Arkansas dentists, the ASDA requests an increase in the current dental Medicaid reimbursement rate, last established in 2007 to be increased for all covered treatments and services at a rate necessary to maintain the current level of providers.By way of this proposal, ASDA demonstrates its long-held objective of advocating for the oral health of our public by advocating for the success and support of our dentists and dental workforce.  The issues facing our dental Medicaid system are many and complex, but we are committed to working together with our fellow stakeholders to find creative and lasting solutions.

Corporate Transparency Act filing deadline approaches

Dental practices must file beneficial ownership reports by Jan. 1, 2025

Reprinted from ADA Morning Huddle, November 14, 2024

Small businesses that meet certain requirements — including many dental practices — must file beneficial ownership information reports by Jan. 1, 2025 before facing penalties.

Enacted in 2021, the Corporate Transparency Act aims to mitigate money-laundering operations posing as businesses. It requires qualifying businesses to report information to the U.S. Department of the Treasury’s Financial Crimes Enforcement Unit about their ownership. The law went into effect Jan. 1. 

Dental practices must file under the Corporate Transparency Act if they employ fewer than 20 people or if they generate less than $5 million (gross receipts) in revenue annually. 

Existing practices will need to report information on both the practice itself, including the legal name, trade names, current address, jurisdiction and tax ID number; and the beneficial owners, including the name, date of birth, residential address, and a valid ID number of either a driver’s license, passport, or state ID, as well as a copy of the form of identification used. 

But what constitutes a beneficial owner?

According to the statute, a beneficial owner owns or controls at least 25% of the business, or exercises substantial control over the business. “Substantial control” includes senior officers of a business, as well as anyone with significant influence over important decisions.

The ADA, which created a FAQ document to help dentists with questions about the Corporate Transparency Act, recommends consulting legal counsel when making determinations on beneficial ownership. ADA has also worked with many other small business groups to advocate for delays to Corporate Transparency Act reporting requirements, but a bill to delay these filings that nearly unanimously passed the House has not yet been taken up by the Senate.

Failure to file a report can result in civil and criminal penalties. Civil penalties include fines of up to $500 per day until the violation is fixed. Criminal penalties include fines of up to $10,000 and/or imprisonment for up to two years.

For more information or to file a report, visit fincen.gov/boi. FinCEN’s Small Entity Compliance Guide walks small businesses through the requirements.

Former presidential candidate makes claims about future of water fluoridation

Reprinted from ADA Morning Huddle, 11/12/24:

National media, including Time.com, reported recent claims from former presidential candidate Robert. F. Kennedy, Jr. that the new Trump administration intends to remove fluoride from the nation’s water supply. The ADA’s well-known position on the public health benefits of water fluoridation is cited in news coverage, such as that adding fluoride to water is a “safe, beneficial, and cost-effective” public health measure and citing studies that it cuts cavities in children and adults by 25%. Immediate-past ADA President Linda Edgar, D.D.S., was quoted by the Washington Post (subscription needed) and USA Today from a previous ADA statement noting, “Decades of research and practical experience indicate that fluoride is safe and beneficial to oral health.” It remains unclear what role Mr. Kennedy will play in the future Trump administration. According to CNN, in a Nov. 9 story by Reuters, the co-chair of Donald Trump’s transition team stated prior to the presidential election that Mr. Kennedy was “not getting a job for [the Department of Health and Human Services].” For more information on community water fluoridation, visit ADA.org.

New information on Medicaid Fee-For-Service program November rollout

The latest issue of the Healthcare Journal of Arkansas features information on Medicaid’s Fee-For-Service program for dental health providers, which rolls out on November 1. The article, by Elizabeth Pittman, is reprinted in its entirety below with the full issue available at this link.

SINCE 2018, the Arkansas Department of Human Services (DHS) has operated the Medicaid dental program by paying Managed Care of North America (MCNA) and Delta Dental of Arkansas (DDAR) a capitated rate for each beneficiary eligible for dental services. MCNA and DDAR were then responsible for paying for the dental claims for their enrolled beneficiaries. Beginning Nov. 1, the dental program will return to fee-for-service, meaning dental providers will bill Medicaid directly for the eligible dental services they provide. Beneficiaries will use their Medicaid ID to receive services, not their MCNA or DDAR cards.

“After careful consideration of dental service utilization, the total program expenditures, and the work underway to ensure a holistic, efficient, and sustainable Medicaid delivery system for all Arkansans, DHS has determined that fee-for-service for Medicaid dental services is both the best and most cost-effective option at this time,” DHS Secretary Kristi Putnam said. “This change shifts management of the program to the DHS Division of Medical Services (DMS), where we will operate it efficiently and effectively. This transition makes better sense for Arkansas patients, dentists, and taxpayers.”

In a letter sent in late May, DHS formally notified the Centers for Medicare and Medicaid Services of the plan to sunset the program and to switch back to Medicaid fee-for-service for dental services instead. The letter also includes a month-by-month transition plan for activities leading up to the targeted Nov. 1 start date. DHS notified both companies that currently operate the managed care dental program of the plan.

Beneficiaries served by the managed care dental program will continue to be eligible for dental services. In the months leading up to Nov. 1, beneficiaries can expect to continue receiving dental services through DDAR and MCNA and should watch for important communications from DHS about this program.

Beneficiaries who are currently enrolled in fee-for-services will continue to use their Medicaid ID card for all dental services. New beneficiaries or those who regained their eligibility on or after Aug. 15, will use their Medicaid ID card for all dental services. Beginning Nov. 1, all beneficiaries who were enrolled in DDAR or MCNA will use their Medicaid ID card for all dental services.

New beneficiaries who became eligible for Medicaid dental benefits on or after Aug. 15 will be enrolled in fee-for-service. Beneficiaries who recently lost Medicaid or Medicaid dental benefits but regained it on or after Aug. 15 will be enrolled in fee-for-service. All other beneficiaries will transition to fee-for-service Nov. 1.

DHS is fully aware that switching to Medicaid fee-for-service will raise questions from providers. Let’s address some commonly asked questions about the change:

Does Medicaid anticipate an increase in reimbursement rates?

Medicaid reimbursement rates are the same as those paid under DDAR and MCNA. At this time, there will be no rate increase in reimbursement rates. Current reimbursement rates can be viewed by visiting ar.gov/dental. Medicaid continuously evaluates rates for all programs.

What services are covered under Medicaid fee-for-service?

Medicaid’s fee-for-service program covers most of the services DDAR and MCNA cover, but some services are not covered. Current covered services can be found in the dental procedure codes table on the arkansas.gov DMS website under the “Helpful Information for Providers: Procedure Code Tables” section. At this time, there will be no changes in the Medicaid covered services, but Medicaid continuously evaluates covered services for all programs.

What services require a prior authorization (PA) under fee-for-service, and how will providers submit PAs?

Medicaid covered services and those that require a PA can be viewed at ar.gov/dental. Dental providers should continue to submit PAs to MCNA or DDAR for services they intend to provide before Nov. 1. Beginning Oct. 18, dental providers should submit all PAs to Medicaid. More information and training on how providers will submit PAs to Medicaid will be provided in the coming months.

How will providers be supported during this transition?

DHS will provide beneficiary-friendly fliers and posters you can print out for your office. AFMC provider representatives will be visiting dental offices in person before Nov. 1, 2024, to discuss the transition, provide job aids, prior authorization information, and contact information for the Provider Relations team and the MMIS billing team. AFMC will also be able to answer any specific questions providers may have.

Additional information about the man-aged care dental program is available on the DHS website at humanservices.arkansas.gov. If you have other questions, please email them to dentalproviderquestions@ dhs.arkansas.gov.

Elizabeth Pitman is the director of the Division of Medical Services. She graduated with a joint law degree and master’s in public health in 2009. After spending a brief time in private practice, she worked as an attorney for Child Welfare Services and Adult Protective Services with the Department of Human Services (DHS). Since 2013, she has spent her career working in policy development with both the Arkansas Department of Health and DHS. Elizabeth’s passion and goal is to make policy that actually works for Arkansans.

ADA Health Policy Institute releases 2024 study on care, coverage, and cost

Using the latest data from Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS), HPI has just released its annual update on trends in dental care utilization, dental insurance coverage and cost barriers to care among the U.S. population through a series of easy-to-read graphs.

Breakdowns by population age, race/ethnicity, income level and insurance type are included.

Among key findings:

  • Forty-five percent of the U.S. population saw a dentist in 2022. While over half of seniors and children had a dental visit that year, only 40 percent of working-age adults did.
  •  Eight percent of children did not have dental coverage, the lowest level in the last two decades.
  • Dental care continues to pose the highest cost barriers when compared to other health services such as medical, prescription drugs and mental health.
  • Disparities in dental care utilization and cost barriers to dental care have remained largely steady over two decades, especially among working-age adults, seniors, people of lower income groups and certain racial/ethnic groups.

Find the full report here at ada.org.

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Obituary: Dr. James Shelton Ellis, ADA Member for 64 Years

Dr. James S. Ellis, 92, of Fort Smith, Arkansas, went home to be with his Lord and Savior on September 29, 2024, in Knoxville, Tennessee. He practiced oral surgery in Fort Smith for 40 years. 

He earned his Eagle Scout Award at age 13 and graduated from Camden High School in 1949. He then attended Henderson University, obtaining a Bachelor of Science degree in chemistry in 1953. In 1956, he graduated from the University of Tennessee School of Dentistry and completed his oral surgery residency at Louisiana State University in 1964.

While attending Henderson University, he met his wife of 67 years, Janette Bryant. They married in 1953 in Camden, Arkansas and had two daughters, Elizabeth and Ruth.

Dr. Ellis served on the Arkansas State Board of Dental Examiners, followed by twelve years of service on the Southern Regional Testing Agency. He was a member of the Fort Smith Dental Association, treasurer of the Northwest Arkansas Dental Association, American Dental Association, Southwest Society of Oral and Maxillofacial Surgeons, American Society of Oral and Maxillofacial Surgeons, and American Board of Oral and Maxillofacial Surgeons.

Additionally, he served on the Dental Staff of Saint Edwards Mercy Medical Center and Sparks Regional Medical Center. After retiring at age 75, he continued to teach Oral Pathology at the University of Arkansas Fort Smith School of Dental Hygiene until he was 84. 

He was a long-time active member of East Side Baptist Church and a men’s Sunday-school teacher. Although he was an avid runner for over 35 years, he also believed in exercising his mind and had memorized most of the Book of Romans. Active in his community, he supported the Fort Smith Symphony and served as president for two seasons.

He was preceded in death by his wife, Janette Ellis. He is survived by two daughters, Elizabeth Hollis of Tulsa, Okla., and Dr. Ruth Lambert and husband Dr. David Lambert of Loudon, Tenn.; two grandchildren, Brandon Son and wife Colleen of Tulsa, Okla., and Ellis Lambert of Loudon, Tenn.; one great-grandchild, Nicole Son of Tulsa, Okla.; and one brother, William Ellis of Fayetteville, Ark.

A graveside service will be held on Saturday, October 5, 2024, at 2:00 p.m., in the Memorial Park Cemetery in Camden, Arkansas.

Memorial contributions may be made to Gideons International, P.O. Box 97251, Washington, DC 20090 or www.gideons.org.  

Proctor Funeral Home is assisting the family in Camden, AR.

Medicaid Begins Provider Outreach Training

Now that the decision has been made to move back to fee-for-service (FFS) for Arkansas Dental Medicaid, the state Department of Human Services has initiated provider training to help dental offices prepare for the coming change following 7 years of managed care.

DHS sponsored its first outreach on July 19 with a webinar in which multiple presenters offered advice and suggestions prior to the November 1 go-live date. Seasoned Arkansas dentists will recall the days of FFS, but many young providers and others who were not Medicaid providers earlier in their career may never have been exposed to the older system. The webinars and other resources outlined below are designed to make the transition easier to understand. The DHS Division of Medical Services will continue to host webinars in the weeks and months to come, and will be available to answer queries from participating dental offices at email addresses and phone numbers located in the July 19 recording below.

Meantime, the managed care organizations (MCO), Delta Dental Plan of Arkansas and MCNA, will continue under the current contract through November 15, but DHS indicated last week that new Medicaid enrollees will not be assigned to either MCO beginning August 15.

Although the move to the FFS system will require ASDA’s attention for the near future, the association’s primary objective is to secure an increase in the Medicaid fee schedule, which has not been updated in 16 years.

Below are available downloads:

Information for Providers – Arkansas Department of Human Services

Recording and Powerpoint from July 19 webinar

Dental Provider Update

Lyon College Releases Plans for New Dental School

Press Release from Lyon College, July 25, 2024:

Lyon College marked a historic milestone today with the groundbreaking ceremony for the Lyon College School of Dental Medicine, the first dental school in the state of Arkansas. The event at the school’s Riverdale campus was celebrated with a symbolic sledgehammer strike, marking the official start of renovations for the new dental school.

“The Lyon College School of Dental Medicine will be a beacon of innovation and excellence, providing comprehensive dental education and services. We will feature an on-site clinic offering high quality dental care to the community, including specialized services for vulnerable populations such as children, the elderly, and those with special needs. This clinic will not only serve as a training ground for our students but also as a vital resource for the citizens of Arkansas, ensuring access to essential dental care, quote said Dr. Burke Soffe, founding dean of the Lyon College School of Dental Medicine. “Our innovative 3 year curriculum is designed to accelerate learning while maintaining the highest standards of dental education. Upon receiving approval from the Commission on Dental Accreditation, we eagerly anticipate welcoming our inaugural class of 80 students. These students will be the pioneers of a new era in dental education in Arkansas, benefiting from high quality facilities and a curriculum that emphasizes both academic rigor and practical experience. Our goal is to cultivate a new generation of dental professionals who are not only skilled clinicians but also compassionate caregivers dedicated to improving oral health outcomes across the state.”

Dr. Melissa Taverner, president of Lyon College, expressed her appreciation for the team behind this historic project.

“This moment represents an incredible achievement for Lyon College and the state of Arkansas. I want to extend my deepest gratitude to our board of trustees, Dr. Soffe, and all of our faculty and staff who are making this school a reality Their dedication and hard work have turned vision into reality, setting the stage for a transformative impact on dental education and health care in our state. Together, we are making history and paving the way for future generations of dental professionals in Arkansas. I especially want to thank the city of Little Rock, the Little Rock Regional Chamber of Commerce and the many other local organizations for their constant support and efforts to make this possible.

U.S. Senator John Boozman praised Lyon College’s efforts and the broader impact of the dental school.

“Establishing a school of dental medicine is an investment in the future of Arkansas. This institution will expand access to dental care by training the next generation of dental professionals to serve our communities. I’m particularly proud of Lyon College’s enthusiasm toward achieving this dream,” Senator Boozman said.

Earlier this year, Senator Boozman championed a $15 million federal appropriation to the Lyon College School of Dental Medicine to address the shortage of dental professionals in Arkansas. Including the 50 States and Puerto Rico Arkansas ranked 50th in the United States – ahead of only Alabama – in the number of dentists per capita with 41.82 per 100,000 residents in 2019, according to the National Institutes of Health’s National Library of Medicine

Arkansas Governor Sarah Sanders also congratulated Lyon College on this significant achievement.

“This is an amazing moment in the school’s 152 year history, for the city of Little Rock and for the entire state of Arkansas. Central Arkansas is our state’s healthcare hub. Just in the past few years, expansions like this one have put us on the cutting edge of the Medical Sciences,“ Gov. Sanders said. “Today, we’re taking another leap and opening the first dental school in the Natural State right here in our capital city. This will only add to the network of doctors, nurses and other medical professionals here who help every Arkansan live a better, healthier life.

Little Rock mayor Frank Scott welcomed Lyon College to Little Rock and Central Arkansas.

“With the Lyon College School of Dental Medicine here in Arkansas’ capital city, it further cements Little Rock’s place as the center for health care and innovation for the entire state of Arkansas, “said Mayor Scott. “We are excited to welcome the state’s first ever dental school to the Riverdale neighborhood and anticipate the positive transformational outcomes for our community from having the best and brightest future dentists who will call Little Rock home. We appreciate Lyon’s trustees, Dr. Taverner and everyone who has worked to make this school a reality as we improve dental care in our city and region.”

Dr. David Hutchison, vice president for advancement at Lyon College, expressed his gratitude to all those who have supported the project. “Oral health is essential to a thriving Arkansas, which is why it matters so much that Lyon College is making this critical, enduring investment in the health of our residents and the vitality of our state. We are deeply thankful to everyone who has contributed to this project, from our dedicated board of trustees and board of visitors to our generous donors and community leaders,“ Dr. Hutchison said. “This groundbreaking marks a significant step forward in improving the oral health and overall well-being of our state.”

 The groundbreaking event brought together community leaders, college officials and supporters to celebrate the start of a new chapter in healthcare education in Arkansas.

Baldwin and Shell Construction Company of Little Rock is construction manager for the project. WDD Architects of North Little Rock is project architect.

For more information about the Lyon College School of Dental Medicine and its programs, please visit lyoninstitute.com or contact Carol Langston at carol.langston@lyon.edu.

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About Lyon College

Lyon College is a private, liberal arts institution founded in 1872. Located in Batesville, Arkansas, Lyon is the oldest College in the state with its original charter. Ranked by U.S. News and World Report as a 2022 “Best College”, Lyon currently enrolls approximately 500 students from more than 30 States and 18 countries. Students can tailor their education, selecting from 25 majors, as well as pre-professional and individualized options. Learn more at lyon.edu.

See the Arkansas Democrat Gazette coverage of the dental school announcement here.

See the coverage from KTHV Channel 11 Little Rock here

See the coverage from KARK Channel 4 Little Rock here